Surgery 1 Flashcards
How can you differentiate between an incarcerated and strangulated inguinal hernia?
Incarcerated hernia
What’s happening?
herniated tissue becomes trapped and cannot be reduced back into place
- Pain but no systemic features
- bowel sounds present
Strangulated
What’s happening?
- Where the blood supply is interrupted
- tender, distended abdomen
- absent bowel sounds
Talk through the Dukes Staging and there 5 year suruvalrates?
A Tumour confined to the mucosa 95%
B Tumour invading bowel wall 80%
C Lymph node metastases 65%
D Distant metastases 5% (20% if rescectable)
Neonate hydroceles are they bad? general management?
Communicating hydroceles are common in newborn males (clinically apparent in 5-10%) and usually resolve within the first few months of life
Reassure its not sinister and will likely resolve within a year.
Blood testing in thyroid disease
What do you test for in Hashimotos thyroiditis?
What do you test for in Graves?
What do you test for in medullary carcinoma of the thyroid?
What use is Thyroglobulin antibodies?
Hash= Anti TPO (thyroid perioxidase) hypo
Graves= Anti TSH rec antibodies (hyper)
Medularry carcinoma = Calcitonin. It is released by the parafollicular cells
Thyroglobulin antibodies- Not useful for clinically distinguishing between different types of thyroid disease, may be used as part of thyroid cancer follow up
What is the strongest risk factor for developing anal cancer?
Other risk factors (6)
HPV infection
Others:
- HPV RFs- Anal intercourse, high lifetime number of sexual partners
- MSM
- HIV and those taking immunosuppressive medication for HIV
- Women with a history of cervical cancer or cervical intraepithelial neoplasia (CIN)
- Immunosuppressive drugs used in transplant recipients
- Smoking
Name a contrainidcation for Suxamethonium the muscle relaxer and why
contraindicated for patients with penetrating eye injuries or acute narrow angle glaucoma, as suxamethonium increases intra-ocular pressure
Complications of thyroid surgery
Electrolyte imbalance?
Presentation? 3
What ECG changes would you see? (2)
Hypocalcaemia
cramps and spasms, paraesthesia of the fingers, toes and peri-oral area.
ECG:
isolated QTc elongation
If very very bad then… isolated QTc elongation
Nasopharyngeal carcinoma
STEM- what ethnicity has hgih risk?
Assoc with what virus + what tye of cancer is it?
When in STEM should you think of this diagnosis/ presentation? (5)
Imaging? (2)
First-line management?
STEM- Southern China
EBV and sqaumous cell
Presentation:
- UNILATERAL otalgia
- Unilateral nasal obstruction or epistaxis
- Unilateral serous otitis media
- Cranial nerve palsies e.g. III-VI
- Cervical lymphadenopathy
Combined CT and MRI
First-line- Radiotherapy
Initial management of acute limb ischaemia? (4)
1. A-E
2.
3.
4.
Definitive management? (5)
- A-E
- analgesia- codeine + paracetamol
- IV unfractionated heparin
- vascular review
- intra-arterial thrombolysis
- surgical embolectomy
- angioplasty
- bypass surgery
- amputation: for patients with irreversible ischaemia
Rectal bleeding- what is angiodysplasia?
Most common in what part of the bowel?
Arteriovenous lesion- cause bleeding which may be massive apart from that little symp
The right side of the colon is more commonly affected.
In repair of AAA which artery can by affected and decrease in blood flow? What condition can it cause?
IMA- can cause ischaemic colitis
Most common type of kidney cancer in adults?
Classic triad of symp?
+ Other symptoms? (2)
Renal cell carcinoma
- loin pain
- haematuria
- palpable abdo mass
- pyrexia of unknown origin, weight loss ect.
Management of the acute phase of vestibular neuronitis?
short course of Prochlorperazine (conventional antipsychotic, stops the vomiting centre) - Should be stopped after a few days as it delays recovery by interfering with central compensatory mechanisms
Management of sigmoid volvulus
Not ruptured =
- If unsuccessful?
Ruptured =
Not ruptured = Decompression via rigid sigmoidoscopy and flatus tube insertion
Second line- percutaneous colostomy tube to decompress the volvulus
Ruptured = Hartmann’s procedure
Patient presents with RUQ pain and jaundice 3 weeks AFTER lapchole, whats the most common reason?
Gallstones may be present in the CBD causing ongoing jaundice and pain after cholecystectomy
Just intubated someone and their sats start to drop fast! why?
oesophageal intubation
Capnography should also be present to confirm the correct siting.
Fibroadenoma
Described as…
Increase risk of malig?
Mx
Described as…Mobile, firm, smooth breast lump - a ‘breast mouse’
Increase risk of malig?
no
Mx
- Will reduce over 2 years 30% get smaller
- Remove if > 3cm
Breast cancer
Determinants for Masectomy over WLE? (4 including size)
DCIS > 4cm- Masectomy
- Large lesion, small breast
- Central tumour
- Multi focal tumour
Breast cancer talk about when radiotherapy is offered, hormonal and chemo (whats given?) and biologics
Radio
- Everyone with WLE to reduce reoccurance up to 1/3
- Masectomy if T3 or T4 and 4 or more axillary lymph nodes
Hormonal
- ER +ve pre-menopausal = Tamoxifen (increases endometrial cancer, VTE and menopausal symp)
- ER +ve post-menopausal = Astronidozole
Chemo
- Given before to downstage a primary lesion or after if axially node disease.
Whats given? 5-fluorouracil, epirubicin and cyclophosphamide.
Bio
HER2 +ve- Trastuzumab
DONT USE IN Hx OF HEART DISORDERS
Contraindications for laperoscopic surgeryn 4 absolutes!!
- Raised ICP-pailloedema
- Haem instability
- Acute GI obstruction and dilated bowel loops >4cm
- Uncorrected coagulopathy
What do you see on ABX in chronic pancreatitis?
Calcification- look closely it looks quite stary
Alarm bells should be ringing with chronic alcohol Hx, abdo pain radiating to or including back pain and no particular pattern coming and going lasting several hours.
Kid has splenectomy- what do you see on blood film 8 weeks later (2/4)
Howell- Jolly bodies
Pappenheimer bodies
Target cells
Irregular contracted erythrocytes
Marjolin’s ulcer- what is it?
squamous cell carcinoma occurring at sites of chronic inflammation or previous injury.
diagnositc investigation/ imaging for aricose veins/chronic venous disease
Venous duplex ultrasound (NOT DOPPLER!!)
Duplex- just doppler plus an image of the veins structure
initial management of acute limb ischaemia
give
1
2
- IV morphine
- IV heparin
Acute limb ischaemia investigations
- 1st line-
- Next step…
- 1st line- Doppler handeld
- Next step… CT angiogram with contrast to assess extent
Acute limb ischaemia investigations
- 1st line-
- Next step…
- 1st line- Doppler handeld
- Next step… CT angiogram with contrast to assess extent
Superficial thrombophlebitis management
1.
2.
3. old school mod/mild-
4. old school severe
- compression stockings (DO APBI FIRST TO CHECK ARTERIAL SUPPLY!)
- LMWH (30 days) or Fondiparinux (45 days)
- old school mod/mild- NSAID topical
- old school severe - NSAID oral + PPI
Always remember that diabetics have an increase in peripheral arterial calcification- therefore ABPI can be higher than expected
